Objective: To evaluate the relative efficacy of two reading programs with and without adjunctive stimulant medication for children with attention-deficit/hyperactivity disorder and comorbid reading disorder (ADHD+RD). Method: Sixty-five... more
Objective: To evaluate the relative efficacy of two reading programs with and without adjunctive stimulant medication for children with attention-deficit/hyperactivity disorder and comorbid reading disorder (ADHD+RD). Method: Sixty-five children (7-11 years) were randomized to one of three intensive remedial academic programs (phonologically or strategy-based reading instruction, or general academic strategy and social skills training) in combination with either immediate-release methylphenidate or placebo.
Multiple-blind procedures were used for medication/placebo, given twice daily. Children received 35 hours of instruction over ten weeks, taught by a trained teacher in a separate school classroom, in small matched groups of two to three. Children’s behaviour and reading abilities were assessed before and after intervention. Results: Stimulant medication produced expected beneficial effects on hyperactive/impulsive behavioral
symptoms (reported by classroom teachers), but none on reading. Children receiving a reading program showed greater gains than controls on multiple standardized measures of reading and related skills (regardless of medication status). Small sample sizes precluded interpretation of possible potentiating effects of stimulant medication on reading skills taught in particular reading programs. Conclusions: Intensive reading instruction,
regardless of treatment with stimulant medication may be efficacious in improving reading problems in children with ADHD+RD and warrants further investigation in a large-scale study.
Multiple-blind procedures were used for medication/placebo, given twice daily. Children received 35 hours of instruction over ten weeks, taught by a trained teacher in a separate school classroom, in small matched groups of two to three. Children’s behaviour and reading abilities were assessed before and after intervention. Results: Stimulant medication produced expected beneficial effects on hyperactive/impulsive behavioral
symptoms (reported by classroom teachers), but none on reading. Children receiving a reading program showed greater gains than controls on multiple standardized measures of reading and related skills (regardless of medication status). Small sample sizes precluded interpretation of possible potentiating effects of stimulant medication on reading skills taught in particular reading programs. Conclusions: Intensive reading instruction,
regardless of treatment with stimulant medication may be efficacious in improving reading problems in children with ADHD+RD and warrants further investigation in a large-scale study.
Research Interests:
Research Interests:
Research Interests:
... Abel Ickowicz, MD, FRCPC, is with the Department of Psychiatry, The Hospital for Sick Children, and the University of To-ronto in Toronto, Ontario. Suggested Readings Bymaster, FP, Katner, JS, Nelson, DL, HemrickLuecke, SK,... more
... Abel Ickowicz, MD, FRCPC, is with the Department of Psychiatry, The Hospital for Sick Children, and the University of To-ronto in Toronto, Ontario. Suggested Readings Bymaster, FP, Katner, JS, Nelson, DL, HemrickLuecke, SK, Threlkeld, PG, Heiligenstein, JH, Morin, SM ...
Research Interests:
... 29-37 An Exaggerated Cardiovascular Response to Methylphenidate in ADHD Children with Anxiety RACHEL URMAN, B.Sc, ABEL ICKOWICZ, MD, PATRICIA FULFORD, RN, and ROSEMARY TANNOCK, Ph.D. ABSTRACT ...
Research Interests:
Research Interests:
The goal of this study was to investigate the effect of methylphenidate (MPH) on response interference, as measured by the Stoop Color and Word Test, in children with attention deficit hyperactivity disorder (ADHD). Response interference... more
The goal of this study was to investigate the effect of methylphenidate (MPH) on response interference, as measured by the Stoop Color and Word Test, in children with attention deficit hyperactivity disorder (ADHD). Response interference is a core component of response inhibition that has been shown to be impaired in children with ADHD. A clinic-referred sample of school-aged children with a confirmed Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of ADHD and good reading skills (n = 31) completed the Stroop Color and Word Test in an acute, randomized, placebo-controlled, crossover trial with three single fixed doses of MPH. MPH did not improve response interference on the Stroop Color and Word Test but did significantly improve color naming and word naming abilities. Response interference, as measured by the Stroop Color and Word Test, is not improved by MPH in children with ADHD. In addition, findings demonstrate strongly positive MPH effects on the highly effortful process of color naming, which has previously been demonstrated as impaired in children with ADHD. MPH was also shown to have a positive but smaller effect on word naming speed.
Research Interests:
... 29-37 An Exaggerated Cardiovascular Response to Methylphenidate in ADHD Children with Anxiety RACHEL URMAN, B.Sc, ABEL ICKOWICZ, MD, PATRICIA FULFORD, RN, and ROSEMARY TANNOCK, Ph.D. ABSTRACT ...
Research Interests:
This study aimed to determine the feasibility of translating cognitive behavioral therapy for anxious youth to rural-community settings via tele-psychiatry training. A 20-week group-supervision training program was delivered to ten... more
This study aimed to determine the feasibility of translating cognitive behavioral therapy for anxious youth to rural-community settings via tele-psychiatry training. A 20-week group-supervision training program was delivered to ten different groups from different agencies within Northern Ontario. Each group consisted of four to nine clinicians with child therapy background not specific to CBT (n = 78, 51 % social workers, 49 % other mental health disciplines). Clinicians were each required to treat an anxious youth under supervision. Changes in clinician knowledge and youth internalizing symptoms were measured. Northern Ontario clinicians showed significant gains on a child CBT-related knowledge test (t (1, 52) = -4.6, p < .001). Although youth treated by these clinicians showed a significant decrease in anxiety symptoms, possible response bias and the lack of a comparison group mandate further studies before generalizing our findings. Nevertheless, training local therapists in anxiety-focused CBT for children via a group supervision based tele-psychiatry model appears to be a feasible and well-received approach to knowledge translation to rural settings.
Research Interests:
Selective inhibition requires discrimination between auditory signals and is assessed using a modification of the stop-signal task. Selective inhibition was assessed in a group of 59 clinic-referred, DSM-IV-diagnosed children with... more
Selective inhibition requires discrimination between auditory signals and is assessed using a modification of the stop-signal task. Selective inhibition was assessed in a group of 59 clinic-referred, DSM-IV-diagnosed children with attention-deficit hyperactivity disorder (ADHD) and compared to that of a community sample of 59 children. Methylphenidate (MPH) effects on selective inhibition were assessed in a subset of the ADHD sample that participated in an acute, randomized, placebo-controlled, crossover trial with 3 fixed doses of MPH. Children with ADHD performed more poorly than controls on the majority of selective stop-signal task parameters: they exhibited more anticipatory (invalid) responses, with less accurate and more variable responses on the response execution task, as well as a slower selective inhibition process. MPH improved speed of both inhibition and response execution processes; it also reduced variability of response execution and decreased nonselective inhibitio...
Research Interests:
Introduction: Retrospective research has become largely undervalued and underutilized in child and adolescent psychiatry with the increasing singular focus on randomized control trials, despite the wealth of clinically relevant data... more
Introduction: Retrospective research has become largely undervalued and underutilized in child and adolescent psychiatry with the increasing singular focus on randomized control trials, despite the wealth of clinically relevant data available in his- torical medical records. In this paper a systematic and scientific approach to chart review research methodology for psychi- atry is described. Method: Informed by available literature, a
Research Interests:
To examine the effects of methylphenidate (MPH) on working memory and behavior in anxious and nonanxious children with attention-deficit hyperactivity disorder (ADHD). A total of 40 ADHD children (22 nonanxious, 18 anxious) completed a... more
To examine the effects of methylphenidate (MPH) on working memory and behavior in anxious and nonanxious children with attention-deficit hyperactivity disorder (ADHD). A total of 40 ADHD children (22 nonanxious, 18 anxious) completed a randomized, double-blind, placebo-controlled, crossover trial with three doses (0.3, 0.6, 0.9 mg/kg) of MPH. A serial addition task was used to assess working memory; direct observation of motor activity indexed behavior. MPH improved working memory in the nonanxious ADHD group but not in the comorbidity anxious group. By contrast, MPH reduced activity level in both groups. The presence of concurrent learning disabilities did not influence stimulant response. The presence of comorbid anxiety in children with ADHD predicts a less robust response to stimulant treatment and suggests that ADHD with anxiety may constitute a distinct and clinically meaningful subtype of ADHD.
Research Interests:
To investigate the effect of methylphenidate (MPH) on visual-spatial memory, as measured by subtests of the Cambridge Neuropsychological Testing Automated Battery (CANTAB), in children with attention-deficit/hyperactivity disorder (ADHD).... more
To investigate the effect of methylphenidate (MPH) on visual-spatial memory, as measured by subtests of the Cambridge Neuropsychological Testing Automated Battery (CANTAB), in children with attention-deficit/hyperactivity disorder (ADHD). Visual-spatial memory is a core component of working memory that has been shown to be impaired in ADHD, irrespective of comorbid reading and/or language problems. A clinic-referred sample of school-age children with a confirmed DSM-IV diagnosis of ADHD (n = 26) completed tests of visual-spatial memory, planning ability, and recognition memory in an acute, randomized, placebo-controlled, crossover trial with three single fixed doses of MPH. MPH effects on right-handed and left-handed motor control were also assessed. MPH significantly improved performance on a self-ordered, updating visual-spatial working memory task and on maintenance of visual-spatial information but had no effects on measures of visual-spatial planning ability or recognition memory. Also, MPH significantly improved left-handed motor control. Beneficial effects of MPH on visual-spatial processing in ADHD are selective and restricted to visual-spatial memory.
Research Interests:
Individuals treated for psychotic disorders and mood disorders with psychotic features have a high likelihood of relapse across the life course. This study examines the relapse rate and its associated predictors for children and... more
Individuals treated for psychotic disorders and mood disorders with psychotic features have a high likelihood of relapse across the life course. This study examines the relapse rate and its associated predictors for children and adolescents experiencing a first-episode and develops a statistical risk-model for prediction of time to first-relapse. A multiyear, retrospective cohort design was used to track youth, under the age of 18 years, who experienced a first-episode of psychosis, and were admitted to 1 of 6 inpatient hospital psychiatric units (N = 87). Participants were followed for at least 2 years (M = 3.9, SD = 1.3) using survival analysis. Approximately 60% of subjects experienced relapse requiring hospital readmission by the end of follow-up, with 33% readmitted within the first year and 44% within 2 years. Median survival time was 34 months. Cox proportional hazards regression identified 4 key risk factors for relapse: medication nonadherence, female gender, receiving clinical treatment, and a decline in social support before first admission.
Research Interests: Psychology, Cognitive Science, Medication Adherence, Social Support, Risk assessment, and 20 moreAdolescent, Humans, Child, Female, Male, The, Psychotic Disorder, Risk factors, Recurrence, Clinical Sciences, Children and Adolescents, Mood Disorders, Sex Factors, Retrospective Studies, Prognosis, Psychotic Disorders, Risk Factors, Risk Assessment, Proportional Hazards Models, and Cohort Studies
Research Interests:
Research Interests: Program Evaluation, Social Work, Mental Health, Community-Based Mental Health Services, Counseling, and 16 moreCurriculum, Humans, Child, Female, Cognitive Therapy, Male, Community psychiatry, Academic Psychiatry, Middle Aged, Adult, Patient Care Team, Mentors, Curriculum and Pedagogy, Clinical Competence, Academic, and Community Based Mental Health Services
To evaluate the impact of adherence and medication status on effectiveness and adverse effects of stimulant use in children with attention-deficit/hyperactivity disorder (ADHD) over 5 years. Seventy-nine of 91 participants in a 12-month... more
To evaluate the impact of adherence and medication status on effectiveness and adverse effects of stimulant use in children with attention-deficit/hyperactivity disorder (ADHD) over 5 years. Seventy-nine of 91 participants in a 12-month randomized controlled trial of methylphenidate and parent groups enrolled in a follow-up study. Adherence to stimulants, treatment response, and adverse effects were evaluated annually for 5 years. Changes in teacher-reported symptoms and parent-reported adverse effects were compared at 2, 3, 4, and 5 years for 3 groups: adherents, nonadherents on medication, or nonadherents off medication. Controlling for age, gender, and baseline severity, adherence status and medication status were evaluated as correlates of teacher-reported ADHD symptom scores at each year using multiple regression analyses. At 2 years, adherents (n = 41) showed greater improvement in teacher-reported symptoms than those off medication (n = 16) and equivalent response to nonadherents on stimulants (n = 16) (p =.02). At 5 years, adherents (n = 16) showed greater improvement in teacher-reported symptoms than nonadherents on stimulants (n = 15) and those off medication (n = 14) (p =.04). At year 2 medication status (beta = 4.67 [0.40-8.95, p =.033]) and at year 5 adherence status (beta = 7.23 [3.01-11.44, p =.001]) correlated with higher teacher-reported symptom scores. Clinically significant adverse effects were present for 5 years, most commonly loss of appetite. Psychostimulants improve ADHD symptoms for up to 5 years, but adverse effects persist.
Research Interests:
To determine the prevalence of obsessive--compulsive behaviours (OCB) in a clinical sample of children with attention-deficit hyperactivity disorder (ADHD) and to compare ADHD children (with and without OCB) with respect to clinical and... more
To determine the prevalence of obsessive--compulsive behaviours (OCB) in a clinical sample of children with attention-deficit hyperactivity disorder (ADHD) and to compare ADHD children (with and without OCB) with respect to clinical and cognitive characteristics and risk factors. We compared ADHD children (n = 134) with and without OCB, and we compared all ADHD children with a group of normal control subjects (n = 26) on various clinical, cognitive, and inhibitory control measures; neurobiological and psychosocial risk factors; and family histories of psychiatric illness. Clinically significant OCB was identified in 11.2% (15/134) of children with ADHD. Comorbid OCB was associated with significantly increased perfectionism, improved teacher ratings of inattention, and a decreased likelihood of having a first-degree relative with ADHD. Comorbid ADHD and OCB may also be associated with increased oppositional behaviour at home and better inhibitory control, though these differences wer...
Research Interests: Genetics, Attention-Deficit/Hyperactivity Disorder, Obsessive-Compulsive Disorder, Adolescent, Family history, and 12 moreCanadian, Humans, Child, Obsessive Compulsive Disorder, Statistical Significance, Risk factors, Inhibitory Control, Cognitive Assessment, Prevalence, Observer Variation, Risk Factors, and Cognition disorders
To describe the properties of a semistructured research interview of parents designed to evaluate attention-deficit hyperactivity disorder (ADHD) and related psychopathology. We examined interrater reliability in 48 videotaped interviews... more
To describe the properties of a semistructured research interview of parents designed to evaluate attention-deficit hyperactivity disorder (ADHD) and related psychopathology. We examined interrater reliability in 48 videotaped interviews randomly selected from a large clinic sample. We examined convergence of the Parent Interview for Child Symptoms (PICS) and Conners' Parent Rating Scale (CPRS) scores in 594 clinic-referred cases and 26 control subjects, comparing the groups generated by cross-tabulation on measures of intelligence, academic achievement, and inhibitory control. Intraclass correlation coefficients for symptom scores of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) were excellent. We found good reliability for diagnoses of ADHD (e = 0.73) and CD (kappa = 0.73) and excellent reliability for the diagnosis of ODD (kappa = 0.80). Two-thirds of cases were classified similarly on the PICS and the CPRS. Greater impairment in inhibitory control was ...
Research Interests:
We compared the predictive validity of attention deficit hyperactivity disorder (ADHD; Diagnostic and Statistical Manual - IV Edition) and hyperkinetic disorder (HKD; International Classification of Diseases - 10th Edition) while... more
We compared the predictive validity of attention deficit hyperactivity disorder (ADHD; Diagnostic and Statistical Manual - IV Edition) and hyperkinetic disorder (HKD; International Classification of Diseases - 10th Edition) while controlling for the presence of comorbid psychopathology. ADHD and HKD criteria were used to classify 804 clinic-referred children ages 6 to 16 years into one of four non-overlapping groups: HKD, ADHD combined subtype (ADHD-C), ADHD hyper-active-impulsive subtype (ADHD-HI), ADHD inattentive subtype (ADHD-IA). Groups were compared with each other and with normal controls (67) while controlling for age and intelligence on a range of criteria both before and after excluding cases with comorbidity. Of the 804 clinic participants, 72 (8.9 %) met criteria for ICD-10 HKD, 353 (43.9 %) for ADHD-C, 142 (17.7 %) for ADHD-HI and 237 (29.5 %) for ADHD-IA. There were no differences among the four clinic groups in rate of comorbidity, neuro-developmental or psychosocial ...
Research Interests:
To explore the prevalence of mathematics disorder (MD) relative to reading disorders (RD) in school-age children with attention-deficit hyperactivity disorder (ADHD) and examine the effects of age, sex, cooccurring conduct disorder (CD),... more
To explore the prevalence of mathematics disorder (MD) relative to reading disorders (RD) in school-age children with attention-deficit hyperactivity disorder (ADHD) and examine the effects of age, sex, cooccurring conduct disorder (CD), and ADHD subtype on this comorbidity. Participants were school-age children (n = 476) with confirmed DSM-IV diagnosis of ADHD. The assessment included semistructured parent and teacher interviews and standardized measures of intelligence, academic attainment, and language abilities. Based on the presence or absence of concurrent learning disorders, we compared the emerging 4 groups: ADHD-only, ADHD + MD, ADHD + RD, and ADHD + MD + RD. Overall prevalence of comorbid ADHD + MD was 18.1%. Age, sex, ADHD subtypes, or comorbid CD did not affect the frequency of MD. Children with concurrent ADHD and either MD or RD attained lower IQ, language, and academic scores than those with ADHD alone. Children with ADHD + MD + RD were more seriously impaired and dem...
Research Interests:
Recently a gene, termed EKN1, has been identified because of a chromosomal breakpoint that occurred in this gene. This chromosomal breakpoint was found in 4 family members that had specific reading disabilities (RDs), indicating that... more
Recently a gene, termed EKN1, has been identified because of a chromosomal breakpoint that occurred in this gene. This chromosomal breakpoint was found in 4 family members that had specific reading disabilities (RDs), indicating that disruption of this gene may be ...
Research Interests:
Recent studies have implicated the involvement of proteins regulating neurotransmitter release in the etiology of attention deficit hyperactivity disorder. On the basis of the role of synapsin III in the modulation of neurotransmitter... more
Recent studies have implicated the involvement of proteins regulating neurotransmitter release in the etiology of attention deficit hyperactivity disorder. On the basis of the role of synapsin III in the modulation of neurotransmitter release, we tested this gene as a candidate contributing to the genetic susceptibility of attention deficit hyperactivity disorder. In this study, we genotyped five markers across the gene on 177 small, nuclear families consisting of an attention deficit hyperactivity disorder proband, their parents, and 43 affected siblings. We examined the transmission of the alleles at each one of these sites and the haplotypes of the polymorphisms using the transmission disequilibrium test. Our observations did not yield any evidence of biased transmission of the alleles at any polymorphism or haplotype. On the basis of the evidence for synapsins in learning and memory from animal models, we also investigated the relationship of this gene to verbal short-term and working memory as measured by digit span forward and backwards. No evidence was found for an association of this gene to these traits. Our findings with this particular sample do not support the synapsin III locus as a major susceptibility locus contributing to attention deficit hyperactivity disorder.
Research Interests:
Attention-deficit/hyperactivity disorder (ADHD) has a strong genetic basis, and aberrant brain dopaminergic and noradrenergic activity is implicated in its etiology. Interleukin-1 (IL-1), its antagonist, IL-1Ra, and IL-1 receptors are all... more
Attention-deficit/hyperactivity disorder (ADHD) has a strong genetic basis, and aberrant brain dopaminergic and noradrenergic activity is implicated in its etiology. Interleukin-1 (IL-1), its antagonist, IL-1Ra, and IL-1 receptors are all present in the brain, and IL-1 has been shown to influence both dopaminergic and noradrenergic function. Recently, Segman et al. [1] tested the IL-1Ra gene, IL1RN, as a candidate for involvement in ADHD. Using the transmission/disequilibrium test (TDT) to examine 77 nuclear ADHD families for the inheritance of alleles of an intronic 86-bp VNTR polymorphism, they found significant evidence for biased transmission of the 4-repeat allele (p=0.04) and non-transmission of the 2-repeat allele (p=0.03). Here, we sought to replicate this in an independent sample of families. In contrast to the previous findings, our analysis of 178 ADHD families showed no evidence for biased transmission of these alleles (p=0.81 and p=1.00, respectively). Our lack of evidence for association of this IL1RN polymorphism with ADHD, based on a much larger sample of families, suggests that the original finding may have been a spurious (i.e. false-positive) result. These findings highlight the need for further investigations of this marker, in additional independent ADHD samples, in the future.
Research Interests: Genetics, Cognitive Science, Attention-Deficit/Hyperactivity Disorder, Polymorphism, Adolescent, and 13 moreDNA, Humans, Child, Female, Male, Polymerase Chain Reaction, Linkage, Pedigree, Genetic linkage analysis, Clinical Sciences, Linkage Disequilibrium, Reproducibility of Results, and Neurosciences
Research Interests:
Research Interests: Genetics, Attention-Deficit/Hyperactivity Disorder, Polymorphism, Cognition, Working Memory, and 22 moreAdolescent, Molecular Psychiatry, Memory, Biological Sciences, Molecular, Glutamate, Ionotropic Receptor, Humans, Child, Haplotypes, Female, Male, Verbal working memory, Animal Model, Inhibitory Control, Genetic linkage analysis, Chromosome, Genotype, Short Term Memory, Verbal Memory, Nino, and Glutamate Receptor
Research Interests: Genetics, Attention-Deficit/Hyperactivity Disorder, Animal Studies, Polymorphism, Adolescent, and 15 moreMolecular Psychiatry, Biological Sciences, Humans, Child, Haplotypes, Female, Male, dopamine receptor D4, Risk factors, Genetic linkage analysis, Genotype, Linkage Disequilibrium, Quantitative Trait Loci, Risk Factors, and Impulsive behavior
Research Interests: Genetics, Attention-Deficit/Hyperactivity Disorder, Polymorphism, Membrane Proteins, Adolescent, and 15 moreMolecular Psychiatry, Signal Transduction, Biological Sciences, Molecular, Calcium Signalling, Humans, Child, Haplotypes, Female, Male, dopamine receptor D4, Calcium Signaling, Pedigree, Linkage Disequilibrium, and Quantitative Trait Loci
Research Interests: Genetics, Attention-Deficit/Hyperactivity Disorder, Polymorphism, Molecular Psychiatry, Quantitative analysis, and 17 moreBiological Sciences, DNA, California, Molecular, Humans, Child, Mice, Female, Animals, Male, Selection Criteria, Ontario, Sample Selection, Quantitative Trait Loci, Quantitative Analysis, Genetic Susceptibility, and Genetic Markers
Long-term effects of psychostimulants on growth in height and in weight are investigated in children with attention-deficit/hyperactivity disorder. Participants were 79 children, 6 to 12 years of age, with attention-deficit/hyperactivity... more
Long-term effects of psychostimulants on growth in height and in weight are investigated in children with attention-deficit/hyperactivity disorder. Participants were 79 children, 6 to 12 years of age, with attention-deficit/hyperactivity disorder, who were followed annually for up to 5 years, between the years 1993 and 1994 and 1998 and 1999. Annual height and weight measurements were standardized by age and gender using the 2000 Centers for Disease Control and Prevention Growth Charts for the United States and reported as z scores. For children taking stimulants throughout the previous school year, dose potency was standardized to methylphenidate in milligrams per kilogram per day. We used hierarchical linear modeling to investigate the influence of dose and duration of stimulant treatment on the rate of growth in height and weight. Controlling for time since initiation of treatment, daily dose of stimulant medication was negatively associated with z scores for height (beta = -.11, SE = 0.03, p <.01) and for weight (beta = -.29, SE = 0.04, p <.01). Estimates based on the statistical model suggest that children receiving > or = 1.5 mg/kg/day methylphenidate will show diminished weight gain after 1 year; those receiving > or = 2.5 mg/kg/day methylphenidate will show diminished gains in height after 4 years. Long-term use of high doses of stimulants during a period of 1 to 5 years is likely to have measurable effects on the rate of growth in school-age children with attention-deficit/hyperactivity disorder.
Research Interests:
To evaluate the impact of adherence and medication status on effectiveness and adverse effects of stimulant use in children with attention-deficit/hyperactivity disorder (ADHD) over 5 years. Seventy-nine of 91 participants in a 12-month... more
To evaluate the impact of adherence and medication status on effectiveness and adverse effects of stimulant use in children with attention-deficit/hyperactivity disorder (ADHD) over 5 years. Seventy-nine of 91 participants in a 12-month randomized controlled trial of methylphenidate and parent groups enrolled in a follow-up study. Adherence to stimulants, treatment response, and adverse effects were evaluated annually for 5 years. Changes in teacher-reported symptoms and parent-reported adverse effects were compared at 2, 3, 4, and 5 years for 3 groups: adherents, nonadherents on medication, or nonadherents off medication. Controlling for age, gender, and baseline severity, adherence status and medication status were evaluated as correlates of teacher-reported ADHD symptom scores at each year using multiple regression analyses. At 2 years, adherents (n = 41) showed greater improvement in teacher-reported symptoms than those off medication (n = 16) and equivalent response to nonadherents on stimulants (n = 16) (p =.02). At 5 years, adherents (n = 16) showed greater improvement in teacher-reported symptoms than nonadherents on stimulants (n = 15) and those off medication (n = 14) (p =.04). At year 2 medication status (beta = 4.67 [0.40-8.95, p =.033]) and at year 5 adherence status (beta = 7.23 [3.01-11.44, p =.001]) correlated with higher teacher-reported symptom scores. Clinically significant adverse effects were present for 5 years, most commonly loss of appetite. Psychostimulants improve ADHD symptoms for up to 5 years, but adverse effects persist.
Research Interests:
The dopamine system plays an important role in the regulation of attention and motor behavior, subsequently, several dopamine-related genes have been associated with Attention Deficit/Hyperactivity Disorder (ADHD). Among them are the... more
The dopamine system plays an important role in the regulation of attention and motor behavior, subsequently, several dopamine-related genes have been associated with Attention Deficit/Hyperactivity Disorder (ADHD). Among them are the dopamine receptors D1 and D5 that mediate adenylyl cyclase activation through coupling with G(s)-like proteins. We thus hypothesized that the G(s)-like subunit Galpha(olf), expressed in D1-rich areas of the brain, contributes to the genetic susceptibility of ADHD. To evaluate the involvement of the Galpha(olf) gene, GNAL, in ADHD, we examined the inheritance pattern of 12 GNAL polymorphisms in 258 nuclear families ascertained through a proband with ADHD (311 affected children) using the transmission/disequilibrium test (TDT). Categorical analysis of individual marker alleles demonstrated biased transmission of one polymorphism in GNAL intron 3 (rs2161961; P=0.011). We also observed significant relationships between rs2161961 and dimensional symptoms of inattention and hyperactivity/impulsivity (P=0.003 and P=0.008). In addition, because of recent evidence of imprinting at the GNAL locus, secondary analyses were split into maternal and paternal transmissions to assess a contribution of parental effects. We found evidence of strong maternal effect, with preferential transmission of maternal alleles for rs2161961A (P=0.005) and rs8098539A (P=0.035). These preliminary findings suggest a possible contribution of GNAL in the susceptibility to ADHD, with possible involvement of parent-of-origin effects.
Research Interests: Genetics, Attention-Deficit/Hyperactivity Disorder, Polymorphism, Personality Assessment, Genomic Imprinting, and 17 moreAdolescent, Dopamine, Humans, Child, Female, Male, dopamine receptor D4, Genotype, Linkage Disequilibrium, Psychiatric, G protein, Genetic Susceptibility, Genetic Markers, Motor Behavior, Maternal Effect, Founder Effect, and Adenylyl Cyclase
We present a descriptfi~e series of four clinical cases of the treatment of aggressive, as well as other severe behavior disorders, of adults with mental retardation and mental illness. In all cases, the patients' aggressive behavior... more
We present a descriptfi~e series of four clinical cases of the treatment of aggressive, as well as other severe behavior disorders, of adults with mental retardation and mental illness. In all cases, the patients' aggressive behavior was diagnosed as being related primarily to their ...
Research Interests:
To measure test-retest reliability of the Stop-Signal Task (SST) and the Conners' Continuous Performance Test (CPT) in children with ADHD. 12 children with ADHD (age... more
To measure test-retest reliability of the Stop-Signal Task (SST) and the Conners' Continuous Performance Test (CPT) in children with ADHD. 12 children with ADHD (age 11.46 +/-1.66) participated in the study. Primary outcome measures were stop-signal reaction time (SSRT) for the SST and CPT's commission errors (%FP). For each participant, we acquired three morning (8:00am) measurements and behavioral observations, separated by two 7-day intervals. Reliability of cognitive measures and behavioral observations was measured using the Intraclass-correlation coefficient (ICC). ICC values for SSRT and %FP were 0.72. Consistency of behavioral observations was much lower (ICC =0.41). Both the SST and the CPT yielded reliable measurements in ADHD children. Our findings lend further support to using these measures in the study of ADHD.
Research Interests: Psychology, Psychometrics, Behavior, Personality Assessment, Attention, and 15 moreAdolescent, Observation, Humans, Child, Correlation, Evaluation methods, Female, Male, Reaction Time, Task analysis, Intraclass Correlation Coefficient, Reproducibility of Results, Attention Disorders, Test Reliability, and Intervals
Research Interests: Psychology, Attention-Deficit/Hyperactivity Disorder, Personality Assessment, Attention, Adolescent, and 13 moreResponse Inhibition, Humans, Child, Discrimination Learning, Female, Male, Reaction Time, Choice reaction time, Inhibitory Control, Abnormal Child Psychology, Abnormal, Reference Values, and Choice Behavior
Research Interests:
Research Interests:
Research Interests:
Twin studies indicate genetic overlap between symptoms of attention deficit hyperactivity disorder (ADHD) and reading disabilities (RD), and linkage studies identify several chromosomal regions possibly containing common susceptibility... more
Twin studies indicate genetic overlap between symptoms of attention deficit hyperactivity disorder (ADHD) and reading disabilities (RD), and linkage studies identify several chromosomal regions possibly containing common susceptibility genes, including the 15q region. Based on a translocation finding and association to two specific alleles, the candidate gene, DYX1C1, has been proposed as the susceptibility gene for RD in 15q. Previously, we tested markers in DYX1C1 for association with ADHD. Although we identified association for haplotypes across the gene, we were unable to replicate the association to the specific alleles reported. Thus, the risk alleles for ADHD are yet to be identified. The susceptibility alleles may be in a remote regulatory element, or DYX1C1 may not be the risk gene. To continue study of 15q, we tested a coding region change in DYX1C1, followed by markers across the gene Protogenin (PRTG) in 253 ADHD nuclear families. PRTG was chosen based on its location and because it is closely related to DCC and Neogenin, two genes known to guide migratory cells and axons during development. The markers in DYX1C1 were not associated to ADHD when analyzed individually; however, six markers in PRTG showed significant association with ADHD as a categorical trait (P = 0.025-0.005). Haplotypes in both genes showed evidence for association. We identified association with ADHD symptoms measured as quantitative traits in PRTG, but no evidence for association with two key components of reading, word identification and decoding was observed. These findings, while preliminary, identify association of ADHD to a gene that potentially plays a role in cell migration and axon growth.